Providing Housing, Food and Medical Support for 25,000 Katrina Evacuees with 12 Hours Notice: The Harris County Medical Support of the Superdome Evacuees

Hurricane Katrina was responsible for trapping 25,000 people in the New Orleans Superdome and isolating many others throughout Louisiana and Mississippi. The transport of these evacuees to the Reliant Park (Houston, Texas) used 500 buses each containing about 55 people. Processing the arriving evacuees included addressing their health status and medical needs as follows: an initial triage at disembarkation, a secondary triage in the Reliant Astrodome and Center, and definitive clinical care in the Reliant Arena "Katrina" Clinic. Baylor College of Medicine (BCM) physicians boarded buses and identified the sickest for emergency transport to Harris County Hospital District (HCHD) hospitals. BCM departments represented included pediatrics, family and community medicine, internal medicine, radiology, obstetrics and gynecology, orthopedics, surgery, and psychiatry. Astrodome and Center triage was managed by BCM physicians and staffed by HCHD Nurses and volunteers from Texas and beyond. The Reliant Astrodome, Center and Arena reached peak headcounts of 15,000,4500, and 2500, respectively Most evacuees visiting the triage sites in the Astrodome and Center were treated using "over-the-counter" medications with the remaining being transported to the "Katrina" clinic. The clinic was equipped with a lab, pharmacy, digital X-ray, and ultrasound machines in addition to electronic patient records created using 80 computer terminals. The Katrina clinic saw more than 15,000 patients during 15 days of operations (2,000 on the first full day), administered 10,000 tetanus shots, and filled thousands of prescriptions. At the peak of operations, the clinic saw 150 patients/hour with 25 physicians scheduled for each 12-hour shift. Approximately 900 people were transported to hospital emergency rooms. Within 3 weeks of arriving at the Reliant Park facilities, more than 90% of the families found permanent housing, enrolled children in schools, and found work. Using data obtained from manual and electronic medical records, this presentation will document the major milestones and lessons learned from this extraordinary project to help the Katrina evacuees

Attitudes, Influences and Perceptions towards Plastic Surgery amongst Medical Students

Introduction: Plastic surgery is a dynamic and evolving field but remains poorly understood due to lack of knowledge, media misconceptions and recent changes to medical undergraduate curricula. To address issues around student interest and recruitment into the speciality, it is imperative to understand the factors influencing medical students and future clinicians. Aims: To examine influences, interest and perceptions of plastic surgery amongst Scottish medical students and explore methods to increase undergraduate engagement. Method: Cross-sectional survey distributed online via Scottish undergraduate medical school offices comprising 6 domains: demographics; career interest; perceptions, interests and influences in plastic surgery; curriculum and trainer views; understanding the role of a plastic surgeon; and undergraduate engagement. Results: A total of 193 students responded with no statistically significant relationship between year group, gender, and interest in plastic surgery. Phrases most strongly identified with plastic surgery included private practice, reconstruction and cosmetics. Placements, teaching staff and workshops/courses were found to influence perception of plastic surgery. Fortunately, only 6% of students encountered antagonism towards plastic surgery encompassing themes of negative stereotypes of surgeons and connotations surrounding cosmetic surgery. Importantly, many students were largely unaware of the range of common procedures undertaken by plastic surgeons. To overcome this lack of awareness and generate greater interest, students suggested greater plastics exposure, consultant-led teaching and workshops showcasing the specialty. Conclusion: Medical students want varied, stimulating and flexible careers – something which plastic surgery can provide. However it seems the understanding of the scope of plastic surgery is poorly understood amongs future trainees. To increase uptake and interest, negative perceptions need to be addressed and greater engagement is required from medical school upwards

Autonomous Medical Care for Exploration Class Space Missions

The US-based health care system of the International Space Station (ISS) contains several subsystems, the Health Maintenance System, Environmental Health System and the Countermeasure System. These systems are designed to provide primary, secondary and tertiary medical prevention strategies. The medical system deployed in Low Earth Orbit (LEO) for the ISS is designed to enable a "stabilize and transport" concept of operations. In this paradigm, an ill or injured crewmember would be rapidly evacuated to a definitive medical care facility (DMCF) on Earth, rather than being treated for a protracted period on orbit. The medical requirements of the short (7 day) and long duration (up to 6 months) exploration class missions to the Moon are similar to LEO class missions with the additional 4 to 5 days needed to transport an ill or injured crewmember to a DCMF on Earth. Mars exploration class missions are quite different in that they will significantly delay or prevent the return of an ill or injured crewmember to a DMCF. In addition the limited mass, power and volume afforded to medical care will prevent the mission designers from manifesting the entire capability of terrestrial care. NASA has identified five Levels of Care as part of its approach to medical support of future missions including the Constellation program. In order to implement an effective medical risk mitigation strategy for exploration class missions, modifications to the current suite of space medical systems may be needed, including new Crew Medical Officer training methods, treatment guidelines, diagnostic and therapeutic resources, and improved medical informatics

Synthesis, Structure and CVD Studies of the Group 13 Complexes [Me₂M{tfacnac}] [M = Al, Ga, In; Htfacnac = F₃CC(OH)CHC(CH₃)NCH₂CH₂OCH₃]

A family of group 13 metal dimethyl complexes of the general form [Me2M{ MeC(O)CHC(NCH2CH2OMe)CF3}] (M = Al (2), Ga (3) or In (4)) have been synthesised by reaction of the isolated free ligand (1) with the corresponding trimethyl-metal reagents. The isolated complexes (2-4) were characterised by elemental analysis, NMR spectroscopy, and the molecular structures of the complexes were determined by single crystal X-ray diffraction which reveals the compounds to be monomeric 5 coordinate complexes with coordination of the pendent ether bearing lariat in the solid state. Thermogravimetric analysis showed complexes 2-4 all to have residual masses, at 200 °C, of 2.4% or less well below the value for the respective metal oxides, and vapour pressure measurements show the indium complex (4) to be an order of magnitude less volatile (0.09 Torr at 80 oC) than the Al (2) or Ga (3) derivatives despite being isoleptic systems. Complexes 2-4 have all been investigated for their utility in the LP-MOCVD growth of the respective metal oxides in the absence of additional oxidant at 400 °C on silicon substrates

Examination of differential ratings of perceived exertion (dRPE) during bio-banded small-sided games.

The aims of the current study were to investigate the use of dRPE with academy soccer players to: 1) examine the effect of bio-banded and non-bio-banded maturity groups within SSG on players dRPE; 2) describe the multivariate relationships between dRPE measures investigating the sources of intra and inter-individual variation, and the effects of maturation and bio-banding. Using 32 highly trained under (U) 12 to U14 soccer players (mean (SD) age 12.9 (0.9) years, body mass 46.4 (8.5) kg and stature 158.2 (14.9) cm) academy soccer players from two English professional male soccer academies. Players were categorised according to somatic maturity status using estimated percentage of adult stature attainment, with players randomly assigned into teams to play 4v4 SSG. The study used a repeated measures design, whereby the selected players participated within 6 bio-banded (maturity matched [pre-PHV Vs pre-PHV and post-PHV vs post PHV] and miss-matched [pre-PHV vs post-PHV] and 6 mixed maturity SSG at their respective clubs. Using mixed and fixed effect regression models, it was established hat pre-PHV players exhibited higher dRPE compared with their post-PHV counterparts. Mixed bio-banded games reported higher dRPE outputs overall. Variation in dRPE measures across a series of bio-banded games are caused by both between and within sources of variation in relatively equal amounts. Across a series of bio-banded games, the four dRPE measures do not provide unique information, and between variation is best expressed by one or two highly correlated components, with within variation best explained by a single equally loaded component. Using a bio-banding SSG design study, we have shown that pre-PHV players report higher subjective measures of exertion than post-PHV players during. Additionally, when evenly mixing players based on measures of maturation, higher measures of perceived exertion were generally reported

Hydroxyapatite coatings on cement paste as barriers against radiological contamination

A novel method for precipitating hydroxyapatite (HAp) onto cement paste is investigated for protecting concrete infrastructure from radiological contamination. Legacy nuclear sites contain large volumes of contaminated concrete and are expensive and dangerous to decommission. One solution is to ‘design for decommissioning’ by confining contaminants to a thin layer. Current layering methods, including paints or films, offer poor durability over plant lifespans. Here, we present a mineral-HAp-coated cement, which innovatively serves as a barrier layer to radioactive contaminants (e.g. Sr, U). HAp is shown to directly mineralise onto a cement paste block in a layer several microns thick via a two-step process: first, applying a silica-based scaffold onto a cement paste block; and second, soaking the resulting block in a PO4-enriched Ringer’s solution. Strontium ingression was tested on coated and uncoated cement paste (~ 40 × 40 × 40mm cement, 450 mL, 1000 mg L− 1 Sr) for a period of 1-week. While both coated and uncoated samples reduced the solution concentration of Sr by half, Sr was held within the HAp layer of coated cement paste and was not observed within the cement matrix. In the uncoated samples, Sr had penetrated further into the block. Further studies aim to characterise HAp before and after exposure to a range of radioactive contaminants and to develop a method for mechanical layer separation

Aesthetic Value, Artistic Value, and Morality

This entry surveys issues at the intersection of art and morality. Particular emphasis is placed on whether, and in what way, the moral character of a work of art influences its artistic value. Other topics include the educational function of art and artistic censorship

Synthesis and characterization of fluorinated β-ketoiminate zinc precursors and their utility in the AP-MOCVD growth of ZnO:F

A novel family of zinc bis beta-ketoiminate complexes 2b-2h have been synthesized by reaction of the isolated free ligands (1a-h) with dimethylzinc. The isolated zinc complexes were characterized by elemental analysis, NMR spectroscopy, and in the case of 2b-d and 2f-h, the molecular structures of the complexes were determined by single crystal X-ray diffraction which reveals the compounds to be pseudo-octahedral 6-coordinate, monomeric homoleptic complexes in the solid state. TG analysis showed complexes 2b-f all to have residual masses at 400 °C of 10% or less, well below the value for ZnO and thus indicative of volatility. Of these systems 2b [Zn{MeC(O)CHC(NCH2CH2OMe)CF3}2] has been investigated for its utility in the AP-MOCVD growth of F –doped ZnO (ZnO:F) in the absence of additional oxidant at 400 °C on glass and silicon substrates

Evaluating the effect of a digital health intervention to enhance physical activity in people with chronic kidney disease (Kidney BEAM): a multicentre, randomised controlled trial in the UK

BACKGROUND: Remote digital health interventions to enhance physical activity provide a potential solution to improve the sedentary behaviour, physical inactivity, and poor health-related quality of life that are typical of chronic conditions, particularly for people with chronic kidney disease. However, there is a need for high-quality evidence to support implementation in clinical practice. The Kidney BEAM trial evaluated the clinical effect of a 12-week physical activity digital health intervention on health-related quality of life. METHODS: In a single-blind, randomised controlled trial conducted at 11 centres in the UK, adult participants (aged ≥18 years) with chronic kidney disease were recruited and randomly assigned (1:1) to the Kidney BEAM physical activity digital health intervention or a waiting list control group. Randomisation was performed with a web-based system, in randomly permuted blocks of six. Outcome assessors were masked to treatment allocation. The primary outcome was the difference in the Kidney Disease Quality of Life Short Form version 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between baseline and 12 weeks. The trial was powered to detect a clinically meaningful difference of 3 arbitrary units (AU) in KDQoL-SF1.3 MCS. Outcomes were analysed by an intention-to-treat approach using an analysis of covariance model, with baseline measures and age as covariates. The trial was registered with ClinicalTrials.gov, NCT04872933. FINDINGS: Between May 6, 2021, and Oct 30, 2022, 1102 individuals were assessed for eligibility, of whom 340 participants were enrolled and randomly assigned to the Kidney BEAM intervention group (n=173) or the waiting list control group (n=167). 268 participants completed the trial (112 in the Kidney BEAM group and 156 in the waiting list control group). All 340 randomly assigned participants were included in the intention-to treat population. At 12 weeks, there was a significant improvement in KDQoL-SF.13 MCS score in the Kidney BEAM group (from mean 44·6 AU [SD 10·8] at baseline to 47·0 AU [10·6] at 12 weeks) compared with the waiting list control group (from 46·1 AU [10·5] to 45·0 AU [10·1]; between-group difference of 3·1 AU [95% CI 1·8-4·4]; p<0·0001). INTERPRETATION: The Kidney BEAM physical activity platform is an efficacious digital health intervention to improve mental health-related quality of life in patients with chronic kidney disease. These findings could facilitate the incorporation of remote digital health interventions into clinical practice and offer a potential intervention worthy of investigation in other chronic conditions. FUNDING: Kidney Research UK

Serial monitoring of genomic alterations in circulating tumor cells of ER-positive/HER2-negative advanced breast cancer: feasibility of precision oncology biomarker detection.

Nearly all estrogen receptor (ER)-positive (POS) metastatic breast cancers become refractory to endocrine (ET) and other therapies, leading to lethal disease presumably due to evolving genomic alterations. Timely monitoring of the molecular events associated with response/progression by serial tissue biopsies is logistically difficult. Use of liquid biopsies, including circulating tumor cells (CTC) and circulating tumor DNA (ctDNA), might provide highly informative, yet easily obtainable, evidence for better precision oncology care. Although ctDNA profiling has been well investigated, the CTC precision oncology genomic landscape and the advantages it may offer over ctDNA in ER-POS breast cancer remain largely unexplored. Whole-blood (WB) specimens were collected at serial time points from patients with advanced ER-POS/HER2-negative (NEG) advanced breast cancer in a phase I trial of AZD9496, an oral selective ER degrader (SERD) ET. Individual CTC were isolated from WB using tandem CellSearch® /DEPArray™ technologies and genomically profiled by targeted single-cell DNA next-generation sequencing (scNGS). High-quality CTC (n = 123) from 12 patients profiled by scNGS showed 100% concordance with ctDNA detection of driver estrogen receptor α (ESR1) mutations. We developed a novel CTC-based framework for precision medicine actionability reporting (MI-CTCseq) that incorporates novel features, such as clonal predominance and zygosity of targetable alterations, both unambiguously identifiable in CTC compared to ctDNA. Thus, we nominated opportunities for targeted therapies in 73% of patients, directed at alterations in phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), fibroblast growth factor receptor 2 (FGFR2), and KIT proto-oncogene, receptor tyrosine kinase (KIT). Intrapatient, inter-CTC genomic heterogeneity was observed, at times between time points, in subclonal alterations. Our analysis suggests that serial monitoring of the CTC genome is feasible and should enable real-time tracking of tumor evolution during progression, permitting more combination precision medicine interventions